Thursday, July 30, 2009
But this whole episode got me thinking about the children that I work with. Many of them over-respond to touch or taste sensations in their mouth. This makes teethbrushing a crazy experience. Suggestions I often give the parent for taste sensitivities is for them to switch brands of toothpaste, switch flavors, try gel not paste, or if worse comes to worse brush the teeth with no paste at all....better than not brushing, heh? For touch sensitivities, some suggestions I often give are to try a vibrating toothbrush, use firmer not softer bristles, and to let the child have some control such as choosing between 2 colors of toothbrushes or counting while brushing. For the young children with more severe touch sensitivity, we often need to work on oral-motor exercises during therapy sessions. Once I find out what works, I show the parents how to perform these exercises. Another idea is for "mouth play" so that occurrences in the mouth are pleasant. After all, these children often are picky eaters too. Some fun things for "mouth play" are to blow bubbles or whistles. Then, after all of that extra work, the child is able to tolerate getting his teeth brushed by someone else or brushing his own!
Tuesday, July 28, 2009
I first knew my daughter had food allergies around 4 months of age...she is now 5 1/2 years old. What gave it away for sure that she had food allergies was that I looked down at her chest when changing her clothes about 20 minutes after I breastfed her, and saw at least 100 little hives on her neck and chest. Since I am a healthcare worker, I was probably alot calmer than most moms. I made her vomit, washed her off, and gave her benadryl. She got worse, so I drove her to the doctor's office. They gave her epinephrine, because by this time she looked white as a ghost yet flushed at the same time. I remember this day like it was yesterday! After thorough testing it was revealed that she was allergic to egg, dairy, nuts, soy and wheat. So, since I breastfed her I had to avoid these foods for then on. The only other choice was to feed her an elemental formula, but those are bitter tasting and expensive. So, I chose to continue breastfeeding her. She has now outgrown all of her food allergies except for dairy, eggs, and red food dye....3 biggies.
In terms of my son, I was absolutely for sure he had food allergies by 2 months of age. But I had my suspicions at 7 days of age when he had projectile vomitting after being breastfed. I know the difference between infant reflux and vomitting, and this was definately vomitting. The other clues were redness around his bottom, a runny nose, mucous in the stool, and a significant amount of gas. He was too young to test for food allergies, so the doctor suggested that I avoid eating dairy, nut and egg products. At 5 months of age he was old enough to be tested and the results revealed: soy, dairy, peanuts, almonds, eggs, and oats. He is now 13 months old. I just recently weaned him and he drinks hemp or rice milk for calcium. On a good note, I was finally able to eat anything I wanted as of last week when weaning was over with....so vacation food was more fun for me!
While packing for the trip I thought of every little outing we would be on and planned accordingly. Most restaurants even add butter for flavor to vegetable dishes, so I brought lots of produce. I got us a room at the hotel that had a small refrigerator for all of my kids' special foods.
It seems like I had to explain many times on our trip why I was bringing in food to an amusement park or other facilities that do not allow outside food. After many minutes of explaining, I was let in with the food each time. The sad thing is that these places sell alot of junk food (nachos, candy bars, slushies with food dyes, etc). My children eat lots of fruit, veggies, and foods with little or no additives. Because of this my kids are probably much healthier than the kids who don't have food allergies!
Most importantly, we had so much fun on our trip. Seeing the smiles on my two children's faces and looking back at the souvenirs and photos makes all of the extra planning worth it!
Saturday, July 25, 2009
Children need predictability in their life. They need to know the rules. This means that parents need to be on the same page, at least most of the time. My children are typically developing, and I find it difficult for my husband and I to agree on all parenting issues. Although, we do agree on most issues. It must be even harder for two parents to agree on their approaches when the child has special needs. Unfortunately, while I am at work it is not an uncommon sight for me to see parents on opposite ends of the spectrum in their approach to parenting. So often, one is more leniant because they are a "softee" or feel sorry for the child. The other parent might be stricter and expect more of the child no matter if he has a special need or not. Of course this depends on the special need, if it is medical, developmental, or learning problems. However, these children need consistency between their parents more than anyone else does.
Some suggestions on how to get on the same page on parenting your child with special needs are:
- Discuss your opinions and how you will respond to things before the situation arises. Do not bicker, argue, or debate in front of your child. This is super confusing for the child and lets them know the two of you are not in agreement. This is especially the case for a divorced couple. So, unless the child is in harm, don't disagree with the other person in front of the child.
- Understand the rules at daycare, preschool, the babysitter's home and other places that your young child may be during the week. Try to use some of those same rules at home. This might include not eating a snack before washing hands. It might be that the word "stupid" is considered a bad word; if they can't say the word at school, don't let them say it at home.
- After therapy sessions (physical, speech, occupational, or other), discuss any techniques that might need to be updated by the parents. If the speech therapist recommended only giving the child a small amount of food at meal time so that the child needs to request more food with sign language or words, then do this at each meal if possible. And all caregivers need to carry this out, not just the parents.
- Be consistent and predictable. If the child's behaviors start to improve, don't all of the sudden switch approaches as this may alter the child's behavior again. Remember, that predictability can be calming. An example may include that if a toddler with feeding problems learned to chew food without gagging after 6 months of addressing the issue, then don't regress to offering him baby food because that is all you had in the pantry. Plan ahead if you need to, but if you let him have the baby food again, you just undid alot of the work. It may take another month to get him to eat table food or not scream when he does eat it.
- Keep open lines of communication. Discussing how to address behaviors that the child displays may need to be done on a regular basis; maybe once a week or once a month.
- Give lots of praise to your spouse in front of the child and in private. It is not easy to be a parent and it is even harder when there are special circumstances
Now, I hope this weekend and next week on our family vacation that my husband and I can be consistent with our parenting styles. I know that times where we are in a hotel and out of our environment can be a true test for us!
Friday, July 24, 2009
Wednesday, July 22, 2009
When my son squeals to get more food, then that is easy to redirect. I remind him to use sign-language for "more" or "drink". I do pause versus doling out food immediately, because he needs to learn patience and not think that his squealing got him the food right away. First, I label his wants, "Oh, you must want more food". He then nods, smiles, or becomes quiet. Sometimes he says "mar" for more or "nana" for banana. I then take my ole' sweet time, and if he remains quiet I give him more food.
When he squeals because his older sister took away his toy, then that is easily redirectible too. My daughter is a great kid, but because she is a perfectionist she says "Mom, I just took the toy away to show him how it should be played with. I'm just teaching him!". Of course, that is not how a 13 month old sees it when his toy is taken away.
When he arches back, squeals, or fusses when he is tired, that is also easily fixed. I put him in his crib for a nap or bedtime. I also try to read the signs that he might be sleepy way before the tantrum comes on. Looking at the clock doesn't work because he is advancing from 2 naps to 1 nap a day, but teetering back and forth. Signs that a toddler may give you that he is sleepy, is being less active, getting mad at the toys, rubbing eyes, yawning, or gazing off. When you miss these signs, crying or tantrums may sneak up on you. This can be easily resolved when you are at home, but not so easily fixed when somewhere else. I try to really look at my son's signals he is sending me before going to the grocery store or doing othe shopping. Because for some reason, I am not found of tantrums in the store.
As previously mentioned in other blogs and my profile, I work with infants and toddlers with special needs in their homes and in the community settings. One of the biggest questions I get asked is how to stop the tantrums. This is a loaded question, because the same behavior of squealing or throwing oneself down on the floor can have different reasons. So, I along with the parents/caregivers become investigators. I need to know what happened immediately before the tantrum as well as: How long ago did he wake up? Is he taking any new medications or new dosages? Has he been ill lately? Any unresolved food allergies? And the list goes on. I try to rule out any medical problems that are beyond the child's control. Often, a child with a language or developmental delay has a tantrum because he can't express his needs or wants, or he may just get frustrated later in the day or before naptime because of the extra energy he exerts having to figure things out. Children with delays have to work a lot harder than children who are typically developing. Other reasons for tantrums are to exert control, poor sensory processing, fear, or anxiety.
Be in tuned with your child and read the signals he is giving you to rule out the basics. Although this blog was aimed more towards the older baby or toddler, babies give off signals of frustration or being over-whelmed as well. They may cry, fall asleep from shutdown, be avoidant, etc. For explanations on why babies cry, go to http://www.sense-ablebaby.com/. Also on that site are ways to calm down a baby as these strategies may keep the baby from escalating into full frustration.
Tuesday, July 21, 2009
Monday, July 20, 2009
Part Two: Sensory Strategies for Adapting the Environment for Young Children with Sensory processing problems/ SPD
Let me start by saying I am a believer in children receiving therapy services at a clinic, but I am also a believer in "home programs". Therapy only occurs a couple of hours per week, but the parents are with the child more of the time and therefore need to learn ways to help the child process sensations more effectively. Therapy helps with the remediation of skills, but that can take awhile. Immediate changes can occur when adapting the environment or altering the way you interact with the child.
Part 1 of this blog gave ideas for children with sensory over-responsiveness and sensory seeking behaviors.
The other categories and ideas are:
- Sensory Discrimination Disorder: this is when it is difficult to detect the qualities of sensations. A problem with auditory processing may be that the child is unsure of what direction a noise came from or can't discriminate if he heard the sound "p" versus "d". A child with a tactile processing problem may not realize he has a wrinkle in his sock or is unsure where he was touched. A child with a vestibular processing problem may get lost in space easily or look clumsy. There are many more symptoms, but these are some basics. Strategies include giving sensory rich opportunities such as those listed for sensory seeking children in Part One. Other ideas include:
Lots of movement as well as mazes and obstacle courses. This is good for visual, proprioceptive, and vestibular processing.
Take the long way when moving between rooms, and march en route.
Lots of tactile experiences such as play-dough, helping to cook, fingerpaint, bath tub toys, and helping to clean (without toxic cleaners).
In order to climb into the carseat, place a stool in the floorboard.
Place a stool or steps at the sink so that everytime the child goes to wash his hands, he is also working on balance.In the car during rides, play a music CDs with words and listen to read-along story books- the type where you turn the page when you hear the ding or chime sound.
- Sensory Under-Responsiveness: seems slow to respond to sensation or being spoken to, may appear not as intelligent as they are because of slow responses, hypotonia (AKA low muscle tone), fatigues easily.
Once again, offer a sensory rich environment such as blankets/pillows for babies to be in tummy time, swings, rocking horse, ride-on toys, exercise balls, ball pit, mini-trampoline, push-pull toys such as a wagon, and tunnels.Use lots of movement whether it be through toys or marching, running, "roughhousing", or bouncing on adults lap as this movement "perks" up the child. Often, balance reactions are better after participating in such activities.
During bathtime have the toddler climb into the tub if possible. Offer lots of toys during the bath.Leave toys lying around the room in various spots, because this is a child that if the house is too tidy, they may not explore. When this is the case, they may get bored and start self-stimming (e.g. rocking back and forth, banging head, flicking fingers in front of eyes, etc.), play with same things in a perseverative way (e.g. blocks must be a tower, can't vere and be a train or house when building), watch too much TV, or just sit there passively.
Give time for the child to respond. He may need a few seconds to decide he wants to play with a toy, move, or answer a question. If he still doesn't respond, he may need a tactile cue such as touching his hand which reminds him to reach for the toy. He may need the toys moved to another location or the room re-arranged. But be patient and don't expect quick changes.
- Dyspraxia and poor motor planning: this is when a child has difficulty with sequencing the steps to an activity or has difficulties executing a task or movement which makes him look clumsy from not knowing where his body is in space. Apraxia is a term used when an adult has lost the ability to motor plan such as after having a stroke (CVA). It is also a term used by speech language pathologists to describe a child who has difficulties with speech and/or oral motor skills due to poor motor planning. These ideas will stick to just the body, from an occupational therapist's (OT) point of view. Adaptations might include:
Set up the room so that things are easily found. Once again, having a home with no toys setting out or in containers high up is not good for this child. Instead put toys in baskets, toy boxes, or low down in invisible containers for easy access to the young child.Set up the environment for success. These children get frustrated when things become too difficult for him. have the layout of their bedroom be simple to maneuver such as the furniture across the walls and the middle of the room an open space.
Have cabinets or shelves in various rooms with safe items for them to manipulate. For example, have a kitchen cabinet without a safety device on it. Items in it could be plastic or wooden bowls, spatulas, etc.
These children need a certain amount of variety, but start to feel out of control if not having a lot of predictability. So the way you schedule your day should be fairly predictable. For example, after getting dressed and a diaper change then go eat breakfast, then play time, etc. This is why many of these tots do better at good daycares or preschool programs as opposed to when at home. Because at these places, the schedule stays fairly predictable. Although lunch may not be the same food everyday, the child knows that before lunch is circle time and that after lunch it is time for a nap. I don't believe that when at home, it has to be super-structured, just predictable.
When you see a dyspraxic child have a meltdown/ tantrum, know that the task may need to be made easier. Break down the activity. For example, if he is upset about trying to feed himself, maybe give some support at the elbow and help him with spearing the food and bringing it to his mouth for that first bite. Then, the next bite give less help. Do this until you are not helping at all. Often, children with dyspraxia just need a little "jumpstart'. This process just described can be either forward or backward chaining, depending if you retreat your help at the beginning or end of the activity.
- Poor postural control:
Although lots of balance activities will help this child to remediate his balance problems, he also needs physical support to be successful until his balance and equilibrium has improved.Choose a high-chair that offers lots of support for the head and trunk. The wooden high-chairs wthat are often seen at restaurants require that the child have good balance, whereas some of the Graco and Evenflo high-chairs that are store bought can recline and have much more support.
Bumbo chair for the infant who can't play with toys simultaneous to sitting up.Limit time the baby or young toddler spends in positional devices. 15 minute increments should be the most a young child spends in a bouncer (stand in)/ jumparoo or other devices.
Although some people swear by putting their baby in a walker, I am not a fan. Studies show that infants who use a walker are actually less likely to walk sooner than those who do not use one. This is partly due to the position a child is in in a walker is more forward as opposed to being upright with shoulders over feet for independent walking.That's it for now!
Now there are numerous more ideas for lil' tots to adapt the environment to improve sensory processing skills. These were just a few I thought of off of the top of my head that tend to work with most young children. However, for some tots, I really have to put on my thinking cap and come up with other ideas.
For "red flags" of sensory processing problems in babies visit http://www.sense-ablebaby.com/ . Although, with babies it is not always so obvious that they have a problem. Sometimes it starts out as just a developmental delay and it later becomes obvious when they are toddlers that their ability to process sensations is not how it should be.
Sensory Strategies for Adapting the Environment to Help Young Children with Sensory Processing Problems / SPD: Part One
Sensory processing is the brains ability to detect and respond to sensory input it receives from the body, other people, and the environment. Young children (toddlers and preschoolers) often respond well to adapting the environment in order to help them process sensations better. Below are some categories of sensory processing problems and some possible ways to adapt their surroundings:
1. Over-responsiveness: these children over-respond to sensations by getting upset, avoidance, shut-down, and/or anxiety.
- Reduce clutter on the walls and floor: this can over-stimulate these children. Organize the room and remove the excess wall decorations. Put toys in containers and baskets versus scattered all over.
- Go shopping at times that are less crowded versus a chaotic time like Saturday
- Give them plenty of space when they are playing next to another child, this reduces the chances of accidentally getting bumped or hearing noises perceived as annoying
- Don't let them be a loner, this is a sign of being over-whelmed. Pair them up with a calmer child on the playground or a calmer sibling at home
2. Sensory Seeking: these children can't seem to get enough of movement, touch, noise, etc. It is like they are driven by a motor. Adaptations include:
- Make sure they have lots of toys and opportunities for movement: swing set, trampoline, tunnels, bicycles, scooterboards
- Give a variety of opportunities for play during daily routines: bath tub toys while bathing, textured fabric on high chair seat or chair cushions, bag of toys to fidget with during car rides, bag of toys to fidget with while in a cart/stroller for shopping trips, etc.
- Look through catalogs that sell sensory integration products. There are many toys made especially for these children. Look for the words "vestibular" and "proprioception" equipment
- Let them sing songs with motions: "wheels on the bus" or "ring around the rosie" are good choices
- As you play with them, have them pretend to be an animal and set the room up for such. If they are crawling around pretending to be a bear, then add large pillows to the floor or crawl through tunnels. Make believe play is good, especially at home when you don't have the expensive sensory integration equipment that is at therapy clinics
Stay tuned for Part 2 to cover the other categories of SPD/ sensory processing problems. Also check out some ideas for working with babies with sensory processing problems at
Would finish now, but I am off to go play with my two children on the floor as we pretend to be snakes slithering on our bellies to provide imaginative play and tactile input to our bellies!
Sunday, July 19, 2009
Babies let us know they are hungry way before they cry. They also let us know they are hungry before the clock might reveal they should. Although most young babies eat every 2.5-3 hours, some eat sooner, especially when going through a growth spurt. Also, formula fed babies tend to not get hungry as quick as breastfed babies because of the calories and contents of formula. The following are some signs the baby may be sending you to let you know it is feeding time:
1. Tries to put fingers, thumb, or fist in his mouth so that he can suck
2. Smacking noises and sucking motions with lips & tongue
3. Fussiness and wiggliness, and eventually flailing limbs if gets too hungry
4. Rooting and if breastfed tries to move toward the breast
5. Fisted hands
6. If the cues are not read and he isn't fed, he will progress to short rhythmical crying. If that is ignored, the crying may progress to an intense waling
Babies need to feel that we meet their most basic of needs. This includes reading the babies signals. Although some parents/caregivers miss hunger signals, other people miss the other signals babies can give us such as when they are bored, over-stimulated, sleeping, or ready to play. A common mistake parents/caregivers make is to feed a baby everytime he cries.
For more detailed information about how to interpret the baby's cries visit http://www.sense-ablebaby.com/. It also includes ways to promote sensory processing in babies.
Saturday, July 18, 2009
I just think it is so bizarre that in third world countries pretty much everyone breastfeeds, and the few babies who aren't nursed often don't survive. This is because the formula doesn't offer anti-bodies to the numerous diseases they are exposed to. Yet, in a developed country like the US, so many women don't breastfeed. Now, I can't judge women who don't. They have their reasons. And as I learned at the course, some women just can't produce breast milk for various reasons. But many of the women who can successfully lactate, choose not to breastfeed. Maybe that is because our society doesn't really promote breastfeeding like it should here in the US. Over in some European countries, breastfeeding rates are much higher, maybe because they can take a maternity leave up to a year.
The reason I named this blog "Back to the Basics" is because there is not one single baby formula out on the market that is superior to breastmilk. They can simulate the DHA and some of the other nutrients, but not all of them! The best thing for our baby is free, and no matter the country or the amount of salary you earn, you usually can lactate. It is so basic, yet here in the US we make it so complicated!
The only person or thing that cow's milk is perfect for is a baby cow (calf)! There are so many formulas out on the market because so many children can't digest a standard formula. There is formula for sensitivities, allergies, and lactose intolerance. But for those women who can't lactate or who choose not to breastfeed, I am thankful for the numerous choices so that babies can be as healthy as possible.
Next week when I return to work, I hope that I can help all of the babies with their feeding problems whether they receive breastmilk from a bottle or directly from their mom, or if they receive formula from a bottle or g-tube. My mission as an OT is to help the babies and their families to be as functional as possible.
So much of feeding is related to understanding the signals given by the baby. Some of these are discussed on my website: http://www.sense-ablebaby.com/